新型冠状病毒肺炎疫情下加速康复外科理念在老年髋部骨折急诊快通道中的应用效果  

Effects of the application of the fast track in treatment of geriatric hip fracture at emergency under the guidance of theory of enhanced recovery after surgery in COVID-19 epidemic

作　　者：石柳[1] 高宇澄 毛进[2] 高旺 张曦文[3] 谢添 范文斌 崔学良 吴旋[1] 李贺[1] 高君义 谢文俊 陈翔溆 钱玉雷 李荥娟[4] 陈辉[1] 芮云峰[1] Shi Liu;Gao Yucheng;Mao Jin;Gao Wang;Zhang Xiwen;Xie Tian;Fan Wenbin;Cui Xueliang;Wu Xuan;Li He;Gao Junyi;Xie Wenjun;Chen Xiangxu;Qian Yulei;Li Yingjuan;Chen Hui;Rui Yunfeng(Department of Orthopedics,Zhongda Hospital Southeast University,Nanjing 210009,China;不详)

机构地区：[1]东南大学附属中大医院骨科,南京210009 [2]东南大学附属中大医院急诊科,南京210009 [3]东南大学附属中大医院重症医学科,南京210009 [4]东南大学附属中大医院老年科,南京210009

出　　处：《骨科临床与研究杂志》2022年第1期28-33,共6页Journal Of Clinical Orthopedics And Research

摘　　要：目的探讨新型冠状病毒肺炎(COVID-19)疫情下加速康复外科(ERAS)理念在老年髋部骨折急诊快通道中的应用效果。方法对COVID-19疫情期间东南大学附属南京中大医院创伤骨科于2020年3月至2021年3月与2021年4月至9月分别通过急诊常规救治流程(对照组)和依据ERAS理念实施优化的急诊快通道流程(快通道组)收治的老年髋部骨折患者197例的临床资料进行回顾性分析和比较。其中对照组154例,快通道组43例。记录两组患者入院等待时间、48 h完成手术百分比、入院疼痛数字评分(NRS)和止痛方式、血红蛋白(Hb)值、血气分析结果(低氧血症发生率)、住院时间和术后并发症发生情况并进行比较。结果快通道组患者住院等待时间大于对照组,入院Hb值低于对照组,总住院时间小于对照组,差异均有统计学意义(P<0.001,P=0.008,P=0.001);两组患者术后住院时间和入院NRS疼痛评分差异均无统计学意义(均P>0.05)。与对照组相比,快通道组入院后无进一步镇痛措施患者比例有上升趋势,需静脉用药镇痛患者比例有下降趋势,术前等待时间呈下降趋势,入院48 h内手术率有上升趋势,术后肺炎、泌尿系感染和谵妄等3种并发症发生率呈下降趋势,但差异均无统计学意义。快通道组和对照组患者完善血气分析比例分别为100%和4.55%。老年髋部骨折患者术前低氧血症发生率为51.2%。结论依据ERAS理念对老年髋部骨折患者急诊救治流程进行优化,建立快通道,可以及时发现患者术前存在的问题,降低患者总住院时间,促进患者的康复。Objective To investigate the effects of the application of the fast track in geriatric hip fracture at emergency under the guidance of theory of enhance recovery after surgery(ERAS)in COVID-19 epidemic.Methods Clinical data of 197 patients with geriatric hip fracture treated in the Department of Orthopedic Trauma,Zhongda Hospital Southeast University were analyzed retrospectively.Among them,154 patients admitted through routine emergency access between March 2020 and March 2021 were assigned to control group(CG)and 43 patients admitted through the emergency fast track between April and September 2021 were assigned to the fast track group(FTG).The perioperative waiting time,the proportion of patients who completed surgery within 48 h of admission,NRS analoguo scale,analgesic treatment,Hb level,blood gas level,hematology alternations,hospitalization time and postoperative complications of the 2 groups were recorded and compared.Results In FTG,the preoperative waiting time was longer than that of CG,the Hb level was lower than that of CG and the total length of hospital stay was thorter than that of CG(P<0.001,P=0.008,P=0.001).There were no significant difference in the length of postoperative hospital stay and NRS value between the 2 groups(all P>0.05).Compared to the CG,the proportion of patients with further analgesic measures after admission was decreased,the perioperative waiting time was decreased,the proportion of patients who completed surgery within 48 h of admission rised,the hospitalization time was decreased,and the postoperative complication was decreased in FTG,but all the differences were not significant.The arterial blood gas analysis was performed in 100%patients in FTG and 4.55%in CG,and 51.2%hypoxemia of elderly patients with hip fracture was found.Conclusion Optimization of the medical treatment process and establishment of the fast track for elderly patients with hip fractures according to the ERAS concept could reduce hospital stay and promote the rehabilitation of the patients.

关 键 词：髋骨折 老年人 急诊处理 围手术期医护 传染病控制 

分 类 号：R47[医药卫生—护理学]